* 1. To register to receive a predental promotional kit, please complete all fields below. Materials will be mailed in advance of your event. Please allow 3-4 week to receive your kit. 

* 2. University Name:

* 3. Chapter or Club name:

* 4. Chapter or Club website:

* 5. Anticipated date of predental event:


* 6. Brief description of event (predental day, career fair, district meeting):

* 7. ASDA would like to promote events on our website for predentals to participate in. If you are interested in having your event featured on our website, please provide the contact email for those wanting to participate in your event.

* 8. Number of materials requested (due to limited quantities, we may not be able to send the quantity you request):